Control the collapse

Optometrists can play a crucial role in highlighting the red flags of intraoperative floppy iris syndrome before cataract surgery, says Rima Evans.

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The risk of intraoperative floppy iris syndrome (IFIS) – a triad of iris billowing, pupil constriction and iris prolapse – can lead to potentially serious complications during cataract surgery, such as iris trauma, posterior capsular tears and vitreous loss (Brennan, 2018). IFIS should be flagged up early to eye surgeons to enable preventative measures, and to patients so a discussion can take place about possible complications. 

IFIS occurs during cataract surgery in up to 90% of patients who are taking tamsulosin (Blomquist, 2011). Tamsulosin is prescribed to treat benign prostatic hyperplasia (BPH), which typically occurs in men over 40 – as many as 90% of men develop BPH by their 70s or 80s. As the UK population ages and the prevalence of both BPH and cataract rises, incidents of IFIS might be expected to rise with them, but risk awareness can reduce incidence (Campbell et al, 2019).

Optometrists are not required to give a detailed and balanced rundown of the risks and benefits of cataract surgery under General Ophthalmic Services, although in some areas they may be commissioned to do a pre-referral or pre-operative assessment, which might include this. Generally, it is the surgeon’s responsibility to examine their patient carefully before operating. But optometrists’ identification of potential risk factors is very helpful in preventing surgical complications from the outset. 

 

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